The AMA Manual of Style is the ultimate go to resource for writing articles as well as understanding ethical standards in medical and scientific publishing, and it is now available online. In the article below, Phil Sefton, ELS, Senior Manuscript Editor at JAMA and a contributor to www.amamanualofstyle.com, looks at words coined backwards. This article first appeared on the AMA Manual of Style site. Read related posts here.
“The patient was ventilated.”
“We decided to ventilate the patient.”
Such statements are commonly overheard in critical care units and other areas when clinicians discuss the care of a patient experiencing insufficient or absent respiration. Both statements use forms of ventilate in ways that—because they appear in this sense in the latest edition of Merriam-Webster’s Collegiate Dictionary—are correct and so may be used in medical journals. However, writers and editors have a valuable opportunity to ensure the continuing precision of the language through careful use of such terms and their variants, referred to as back-formations.
As discussed in the 10th edition of the AMA Manual of Style, “Back-formation is the creation of a new word in the mistaken belief that it was the source of an existing word” (see §11.3, Back-formations, in the AMA Manual of Style, p 407 in print). Back-formations are formed by the removal of a suffix (either a derivational suffix such as -ion or an inflectional suffix such as the plural -s) from a word that actually appeared first, changing its part of speech and forming a new word. Thus, the verb ventilate when used in the clinical sense may well be such a form, as suggested by its appearance in common use slightly later than the appearance of the noun ventilation (early 1900s vs 1890s, respectively).1 Interestingly, however, users of the English language had been busily back-forming for some time before that: ventilate as used in the closely related sense of exposing the blood to air, now obsolete or nearly so apart from its use in the study of physiology, likely also represents a back-formation that appeared some 50 years after ventilation as used in this sense (1660s vs early 1600s, respectively).2
Back-formation plays a valuable role in language evolution, producing neologisms that often subsequently enter common use. However, coining verbs through back-formation can result in medical jargon (see §11.4, Jargon, in the AMA Manual of Style, pp 408-409 in print) that is vague, depersonalizing, and sometimes downright comical in the images it can evoke. Taking the case in point, for example, what does “the patient was ventilated” mean, exactly? Was the patient perforated? Fitted with louvers? Left outdoors?
While it is commonly understood that the use of ventilated in this sense in spoken English denotes the use of a mechanical ventilator or other means of artificial respiratory assistance (eg, use of a bag-valve-mask apparatus), it typically refers to the former. However, in